Provider Demographics
NPI:1598783813
Name:KIM, YI SUN (MFTI)
Entity Type:Individual
Prefix:
First Name:YI SUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21209 BLOOMFIELD AVE
Mailing Address - Street 2:42
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-2368
Mailing Address - Country:US
Mailing Address - Phone:562-841-3810
Mailing Address - Fax:
Practice Address - Street 1:18200 YORBA LINDA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4061
Practice Address - Country:US
Practice Address - Phone:562-841-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist